Healthcare Provider Details

I. General information

NPI: 1851631097
Provider Name (Legal Business Name): MODEL DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 12/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 OAK PARK BLVD SUITE 101
PISMO BEACH CA
93449-3405
US

IV. Provider business mailing address

1506 DRAPER ST
KINGSBURG CA
93631-1909
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-5111
  • Fax: 805-481-5729
Mailing address:
  • Phone: 805-481-5111
  • Fax: 805-481-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY51269
License Number StateCA

VIII. Authorized Official

Name: RASMIK ZAKARIAN
Title or Position: PRESIDENT
Credential:
Phone: 559-897-5111